中国血液净化

›› 2004, Vol. 3 ›› Issue (11): 587-589.

• 论著 • 上一篇    下一篇

联机尿素清除率监测和常规采血计算Kt/V对血液透析充分性评估的对照研究

谢 华 林洪丽 李 平 陈丽光 王松岩 冯 青   

  1. 116001 大连，大连医科大学附属第一医院肾内科(谢华，林洪丽，李平，王松岩，冯青)旅顺口区第二人民医院内科(陈丽光
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-11-12 发布日期:2004-11-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-11-12 Published:2004-11-12

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摘要：

目的 通过前瞻自身对照研究探讨无创联机尿素清除率监测评估血液透析充分性的可行性和准确性。 方法 随机选取规律血液透析患者60例，其中男性30例，女性30例，平均透析时间(86±23)个月，透析中血流量220～300ml/min，透析液流量500ml/min，根据患者既往的Kt/V值设定当次透析的Kt/V值，利用联机尿素清除率监测 (Online Clearance Monitoring OCM)；同时透析前后取血液透析患者全血检测尿素氮浓度，根据Daugirdas公式计算并校正Kt/Ve值作为对照，比较两种方法的相关性及不同体表面积、超滤量对二者的影响。结果 本组60例患者利用OCM 与常规方法所得的 Kt/V 值分别为 (1.50 ± 0.18)， (1.62±0.48)，直线回归分析相关指数γ=0.747， P＜0.001。不同体表面积 ≥ 1.73 m2 及 < 1.73m2的两组患者，OCM监测的Kt/V值分别为(1.28±0.07)，(1.67±0.45)二者有显著差别 (P＜0.05)；常规计算的 Kt/V值分别为(1.47±0.15)，(1.52±0.19)，二者无显著差别。不同超滤量≥3Kg及<3Kg的两组患者，Kt/V值无显著差别。结论 对维持性血液透析患者的单次血液透析OCM和常规方法所得的Kt/V值相关性较好，而且这种方法操作简便，能保证患者单次透析的充分性，可以在临床上推广。

关键词: Kt/V, 联机尿素清除率监测（OCM）, 血液透析

Abstract:

Objective To investigate the feasibility and accuracy of online clearance mornitoring(OCM)in assessing hemodialysis adequancy by a prospective auto-control study. Methods Sixty patients with maintenance hemodialysis were investigated on OCM appliance,whose average hemodialysis duration were (86±23) ms,blood flow was 220～300ml/min,dialysate flow was 500ml/min.Meanwhile,blood urea nitrogen(BUN) of pre-and post-dialysis were examined.Then caculate Kt/V according to the equation Daugirdas and evaluate the correlation between Kt/V by OCM and by calculation.Kt/V by OCM and by calculation were also compared in different body surface area and ultrafiltration volume. Results Kt/V by OCM and by calculation was (1.50±0.18)vs(1.62±0.48) respectively, γ,the correlation coefficient of linear regression analysis,was 0.747(P＜0.001).In group A(body surface area ≥1.73m2) and group B(body surface area＜1.73m2), the Kt/V by OCM was (1.28±0.07) vs (1.67±0.45) respectively,the difference between them was significant; the Kt/V by calculation was (1.47±0.15) vs (1.52±0.19) respectively, there was no significant difference between them.And there was no significant difference in Kt/V in the group with ultrafiltration volume ≥3Kg and the group ＜3Kg. Conclusion Correlation between Kt/V by OCM and by calculation was satisfactory. The operation of OCM was convenient and can guarantee hemodialysis adequacy. OCM could be applied in clinic widely.

Key words: Online clearance monitoring(OCM), Hemodialysis

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